Healthcare Laundry and Textiles in the United States: Review and Commentary on Contemporary Infection Prevention Issues

Abstract

Healthcare professionals have questions about the infection prevention effectiveness of contemporary laundry processes for healthcare textiles (HCTs). Current industrial laundry processes achieve microbial reductions via physical, chemical, and thermal actions, all of which result in producing hygienically clean HCTs. European researchers have demonstrated that oxidative laundry additives have sufficient potency to meet US Environmental Protection Agency benchmarks for sanitizers and disinfectants. Outbreaks of infectious diseases associated with laundered HCTs are extremely rare; only 12 such outbreaks have been reported worldwide in the past 43 years. Root cause analyses have identified inadvertent exposure of clean HCTs to environmental contamination (including but not limited to exposure to dust in storage areas) or a process failure during laundering. To date, patient-to-patient transmission of infection has not been associated with hygienically clean HCTs laundered in accordance with industry process standards. Occupationally acquired infection involved mishandling of soiled HCTs and failure to use personal protective equipment properly. Laboratory studies of antimicrobial treatments for HCTs demonstrate a wide range of activity from 1 to 7 log10 reduction of pathogens under various experimental conditions. Clinical studies are needed to evaluate potential use of these treatments for infection prevention. Microbiological testing of clean HCTs for certification purposes is now available in the United States. Key features (eg, microbial sampling strategy, numbers of textiles sampled) and justification of the testing are discussed.

Programas de Controle de Infecção Hospitalar: avaliação de indicadores de estrutura e processo

“…Despite the fragility of studies in the area, the contamination of aprons, uniforms, and white coats with resistant isolated bacteria from patients hospitalized has been already proven. This reinforces the need for recommendations and actions by the HICC to cease and minimize the pathogenic potential posed by such clothing (14)(15)(16)(17) .…”

Microbial aerosol liberation from soiled textiles isolated during routine residuals handling in a modern health care setting

“…Based on conventional monitoring methods, government agencies and professional societies have published guidelines suggesting acceptable ranges for operation hospital/clinical building HVAC systems [ 1 ], as well as best practices for handling contaminated textiles and other residuals (i.e., regulated medical wastes) in these unique indoor environments [ 2 ]. While the association of infectious microbes with a wide variety of hospital materials has been indicated by culture-based techniques, the advent and affordability of real-time optical monitoring, together with established molecular techniques, have precipitated new efforts to determine indoor bioaerosol and fomite liberation potential from health care workers’ activities.…”

The role of textiles as fomites in the healthcare environment: a review of the infection control risk

“…Case studies have reported small outbreaks or colonisation of patients associated with contaminated linen or laundering equipment (Sehulster, 2015). Three studies in the published literature implicate contaminated healthcare worker uniforms with HCAI outbreaks (Table 3).…”